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Hello you, I'm sorry it has been a while and thank you for waiting with me and for me. Over a year ago, I had the misfortune of encountering a monstrous being. Someone who fundamentally shook my belief in man's capacity to be decent and good. This experience was my un-doing. It took me months to name the injustice that was done to me. And many more months to even say it aloud. A year down the line I'm still floundering emotionally and physically to process the whole experience. Disbelief - did this really happen, did this really happen to me. Shame - I'm an intelligent being...I should've seen this coming. Anger - I didn't deserve this. I've led a good life. I'm a decent human being. How could this happen to me? Pride - I'm a statistic??!!! Then I have emotions, which I can neither place nor name yet they're as present as my every breath. In foreign Territory I wasn't joking when I said this was my un-doing. You know it's bad when even my Faith is shaken. At the time, I wrote 'at my mother's feet'. A poem which expressed that chapter of my life. Then I stopped writing. Correction, I couldn't write. In fact I couldn't do very much beyond the day to day - Mass, work, eat, sleep, parents, volunteer, repeat. I lost my voice. It wasn't just other people I couldn't trust. I couldn't trust myself and my judgement. So, my voice joined a bandwagon of things I couldn't trust and thus begun the unscheduled hiatus. To be honest, I wasn't sure I'd be able to write again, ever. And after a while, I got scared of writing. What if I couldn't anymore? What if I had nothing to say? First forward 15 months later, here we are ... I'm taking it one day at time and keeping my fingers crossed. Healing A few years back in the thick of the pandemic, I found myself listening to a live Instagram interview. A woman called Alex Elle was being interviewed. I can't tell you who was interviewing her or what the interview was about. But I remember this one statement she said that captured my attention at the time. ''....life is not linear...'' Life is not linear. It just isn't. I often add, that Life does what life does best, it happens. In the year or two since that interview, I've found myself often returning to this statement. I've used in my consult room with my patients especially when unexpected things happen. Life happens Life happens. Some chapters are like the perfect Summer's day and others are darkest loneliest scariest storms. From a human perspective, there is no rhyme or reason as to why life unfolds a certain way for one person and a different way for another. There's no explanation as to why today the storm is at one person's doorstep and while there is sunshine on their neighbours. There's no reason why 'the storm' made an appearance on my doorstep the day it did. There's not a single thing that one can do to merit either the sunshine or the storm. No amount of money or good deeds will keep away the storm. Let me give you an example. I'm borrowing from the lives of patients who I've had the privilege of looking after over the years. (All identifiers have been changed and pseudonyms used to ensure patient confidentiality.) Athena, a young mother in her 20s came in with complications of end stage metastatic lung cancer. She had started coughing blood, which on investigation revealed she also had clot in the lung as well as the cancer. She had never smoked a day in her life. No one in her family smoked. She had not worked in any industry that might predispose her to lung cancer. Yet there she was, dying of lung cancer in her 20s. She'd stopped asking 'why me' and was trying to make most of the days she had. Boreasine, a fiercely independent woman in her 90s and who'd lived quite the life as she put it, also came to see me. She had been smoking since age 9 years old. She had a mild chest infection but what she really wanted to share with me the consultation were the latest pictures of her great grandchildren. Other than some poor dentition, mild changes to her chest X-ray and tar stained fingers and nails, she was a picture of health. Literally. This chapter of her life was pure Joy and Happiness. Pure Sunshine. Caeser, a 40 year old ex-service man finally returned home after a couple of tours and was found to have metastatic melanoma. A form of aggressive skin cancer. He had only been married a few years and had a young family. Unfortunately he died a year or so after his diagnosis, in a public toilet of brain haemorrhage, apparently a complication of the melanoma. Deandre-Ann, an African immigrant in her late 40s was finally giving birth to her child with the assistance of IVF, after more than a dozen miscarriages. She came in a few weeks later to see me for her 6 week postpartum check with her newborn baby. She was full Joy but there was also deep sadness in her eyes. When we started discussing her support system and who was at home with her, her eyes welled up in tears. She told me her great Joy has been accompanied by a great loss. The love of her life, had left her not long after her delivery. She had the support of her mother who had moved in to help her. For Deandre-Ann, the 'storm' arrived on heels on her 'sunshine'. Equestriana had found her way into the U.K. after escaping from war. She had settled quite well and was working in finance. She was in her 30s. She came to see me for a medication review consultation. The most striking thing about her was there was not an ounce of emotion in her demeanor, face or voice. Before she left my consult room, I asked her a bit more about herself. The floods gate opened. When she eventually settled. She told me she was an orphan as consequence of the war in her country. Once she had settled, she wanted a child and after much difficulty was able to conceive and deliver a healthy child. She finally had the life she'd dreamed and worked so hard for, in the house of her dreams. About 6 months into this dream, the storm came again, this time it took the form of a terminal illness. Her prognosis she was told was 6 months. Other than her child, she was completely alone in the world. Her sorrow she said was not because she was dying as death comes to all. Her sorrow she said were for her son, that she was about leave behind alone in this world. She was bitter. And life happens Sitting in my consult room each day and encountering hundreds of souls has taught me that there is not a single thing that one can do to merit or buy their way around life. Yeah you can buy materialistic stuff and experiences. But when it comes to life.....well... it happens. It has it's own rhythm. Sunshine and Storms The Sun shining can come in any form. It can be a whole chapter in life like Boreasine's story. Or it come in little pockets of joy every day, such as the laughter of a child, wonderful meal, or joy in a loved one's face. The trick is to look out for it. And to quote Alex Elle, when you find it, 'Seize it', and squeeze every drop of Joy out of it. The same is true for the storm. It can come in any form. In the examples I've used, the storm takes the form of an illness. But it could be anything. It could be the loss of a job, a demotion, a failed exam, a sexual assault, death of a loved one, holding the hand of loved one suffering with a chronic illness or dying, unfaithful partner, a difficult marriage, an unwell child. It could be war. It could be a series of little disappointments that slowly erodes. Whatever the case, hold on. Be gentle with yourself. Anchor yourself firmly to your loved ones and the things that restore you. Remember, every single emotion you'll feel is valid. Even the ones that you can't quite name or describe. Remember that much like life, healing is not linear. Be Patient. Be compassionate with yourself. Give yourself time. There's no time limit on healing. It takes as long as it takes. https://www.brendaosieyo.com/items/at-my-mother's-feet

A curious dissection or reflection of sorts following one of 'those' racist experiences. I hope it'll help shed some light on some of the emotions and thoughts associated with these experiences within a healthcare setting. If it helps one other person, then it has served its purpose. Early encounters of racism in Medical School The first time I experienced racism in the profession wasn't from patients. Nope. It was from my peers. It was actually on my first day in Medical School. I had the misfortune of being within earshot of a discussion about my inclusion into the School of Medicine. They didn't think it was based on merit but through positive discrimination. I should add I was the only black student in my cohort. A few weeks later we started going on rounds with our clinical educators/consultants. During one of those clinical sessions on the ward, I vividly recall one of the consultants teaching us that we should never examine black peoples' feet as we may 'catch a disease'. It left me contemplating my black feet, which were firmly attached to my black body. The worst thing about these moments and the subsequent 'little' ones which, would follow was that no one spoke up. There was no dissent. Everyone nodded along and took notes. A few people laughed. I doubt they even recall these moments. Yet, this was to become my template for the next 4 years. The odd racist comment, nod, laugh, occasional jotting of said points and move it along. No one stood up. Admittedly, not even me. Sometimes when I'm feeling more 'racially resilient', I feel ashamed for failing to stand up for myself. Then I remember I was a black African, 1st generation female immigrant with a 'Kenyan-ish, 'African-ish' British-ish, Other-ish accent. Yeah...I wasn't about to open my mouth. I knew better by this stage in my life. The promise Naturally, I made a promise to myself after the first handful of encounters. 'I would try to be as invisible as possible in those spaces'. It was the only way I could think of to survive. That is exactly what I did. I tried my best to keep my head down and just survive. I was scared most of the time. Public spaces were particularly difficult - buses, trains, malls... Even shopping for basic necessities such as food was tricky. I went as early or late as I could - fewer people meant safer. I attended a handful socials in the 4 years I was there. To survive, I had to lose my voice. Then, I lost as much of myself as I could because ironically, blending with the walls was impossible. So, it's not entirely surprising that I hated every minute of medical school. My grades took a to hit. The clinical rotations in the last year were particularly difficult. We rotated every few weeks, through different towns, having to live there during those periods. If I didn't feel safe in med school, I felt even more unsafe and unanchored in the other towns. I felt like the only black person within miles. I suspect this was not the case, but that's what it felt like. TO THIS DAY, I still have the urge to shrink and blend with the walls whenever I step into healthcare spaces especially clinical meetings, healthcare education seminars and conferences. Any spaces with my peers in it. I'll admit that after new racist moments in the healthcare setting, I'm so triggered that for the next few weeks or months, I'll avoid certain spaces. It is the only way I know to feel safe, and it has served me well over the years. Admittedly, things are a better of course. I have a handful of people in my current workplace, who've showed me through their actions what ANTI-racist allies look like. It's different from ambivalent allies. That's a thing. Having my allies has helped me re-discover a little bit of what I lost....my voice and slowly by slowly I'm getting some pieces of me back. This is one of the reasons I can talk and write about this now... this year. The encounter 'I didn't see it coming'. Sometimes you do. Sometimes people do and say exactly what you think they're going to. Not this time. I didn't expect it from this particular patient. I'd had previous consults with them. The Covert Racism started when my Caucasian colleague stepped into the room. It caught me completely off guard. When the patient left the consultation room, and my colleague called it out for what it was...validating it....it gave me the permission to face it. On reflection, it wasn't the first time I felt like I needed validation to callout racism in healthcare when directed at me. I had allowed it to become the norm. This 'ugly' experience got to me in a way that, still confounds me. I've experienced my fair share of racism in healthcare both as a professional and patient. I don't scare easy, but this particular experience got under my skin. *It is also not how I experience ALL forms of racism. Most of the time, I laugh things off, take the experiences home to my parents and siblings, some friends. Shock and Denial. This emotion was the easiest to recognise. I felt completely numb for the rest of the day after that incident. 'It can't be happening' and it sure as hell not happening to me - again. I was trying to un-experience or re-write the narrative to something more palatable such as overly sensitive, it's all in my head, I misunderstood etc. Anxiety and Fear. Fear associated with feeling deeply vulnerable and unsafe in that moment and in the days which followed. If it had been possible to peel of my skin during that consultation for some relief and return to it later... I would've done it. I sought refuge in my medical school survival techniques. Shame. I don't fully understand this emotion, but it was present. It clung to my skin. In retrospect, that shame is often present after these encounters. Then, I feel ashamed for feeling the shame. It's complex and mind-boggling to me. Self-isolating. With the anxiety, fear and shame, there was only one way forward retreat and I swallow the emotions and the tears. I didn't feel anyone would get it. I didn't think they'd be enraged by it too. So retreated into myself. * I knew I'd hear many versions of sorrys...' sorry this happened to you'... But I would also hear '...are you sure you're not being sensitive? '...'could you have misinterpreted the situation/words/actions'....'they didn't mean it, or they didn't mean it like that'..'. I've known them for ever and it's unlike them'.... maybe they're just having a bad day .... it's just their age...'or eyes...their generation or culture.... Sad. Like all humans who call this planet our home, I too have a right to exist and feel safe. Yet, these experiences serve as a stark reminder that I'm not safe or as safe because of my skin colour. Not to mention, who wants to carry the emotional/psychological scars/baggage of these racist experiences. Not me. After the experience Typically, if an experience has gotten to me, I'll try where possible to lean on my colleagues a bit more. I'll often mention, I've had a challenging consult and ask if they mind anchoring me. Then I'll crack on with it. Why??? because existing in certain spaces in this world means one is often taught to master the art of silence. One has to know when NOT to speak. I mastered the art when I was about 14 or 15 years old and became better at it in medical school. It's almost instinctual now. No room at the inn This time there was no room at the inn. None. All the experiences that'd swallowed over the years flew back out. I sat down in my consultation room the following morning and sobbed. I tried to pull myself together. I sobbed. The Allies At some point during the sobs, I discovered The Allies. Or rather, they came to my aid in the most human, compassionate and practical ways. Experiencing them in action was one of the best things that came out of this experience. So, in many ways I'm grateful there was no more room at the inn for my racist experiences. The sobbing set into motion a series of events that led to this discovery. All I did was sent short message to one of my colleagues and with them came a little team of 7 - 8 people who rallied around me. What I found helpful Time out. They understood better than I could in that moment, that I could not safely (emotionally and psychologically) continue in the consultation room where said experience had occurred. They insisted, that I power down and accompanied me a place of safety. There was something about this moment that made me feel more seen, understood and embraced, in a way that was novel to me. They understood what I was not able to verbalise. Privacy. I was allowed the privacy I needed both on that 'sobbing' day and in the days that followed. I was supported and nursed back to my consultation room seat. It's taken about 10-12 weeks to feel like my old self. I know this because my anxiety became a real issue during this period and has only recently settled. Action and words. An appropriate message was sent from the organisation in solidarity. They didn't try to explain away the experience. They didn't add to my shame or make feel guilty/weaker. They definitely didn't try to explain the experience to me. This opened up space for compassionate conversations of understanding and learning from each other. One of the most enlightening moments for me came when I was asked, 'why didn't you leave the room or ask them to leave the consultation room? How could you just sit there and endure that type of abuse?' 'What I said was that as a black African female healthcare professional, I don't feel I have the agency/power/social currency. I have to tread lightly.... It would've better for me to have been physically assaulted in that consultation room than being racially abused. People, especially 'ambivalent allies' seem to understand and better support people who've been physically assaulted '. The choice Racism has no place in healthcare or our world. None of us has a say to whom, how or where we're born. But we ALL, individually and collectively, have a CHOICE when it comes to racism. Antiracism is a choice. Ambivalence is a choice. Silence is a choice. In sharing my story despite feeling really vulnerable doing so, I want to think I'm making a different choice. I refuse to be complicit with my silence. I'll try to speak up more...especially when I'm scared. Admittedly, it's easier with allies. I hope it makes someone who is in the thick of it, feel less alone.

For my colleagues at home and around the world who are struggling. Hello you, I hope this finds you well. I hope you're anchored and safe. BUT ... if this finds you unanchored, then... this is Especially for you. These words flowed out of me in response to a colleague who was in distress. She is now in a much better space and is receiving the care that she needs. What struck me though....and still does....was that it turns out these were also the words that I too, needed to hear. If it wasn't for her, I'm not sure I'd I've written these down. They have become the words I use for me when I'm not okay. I'm grateful for her courage. I'm gifting them forwards...to YOU dear friend. Why? Because we have to look after each other. If we don't then who will??? Let me start with this, I'm sending you a MASSIVE virtual hug. I know it's scary to hold a mirror to yourself sometimes. Perhaps, it's because you're too tired to do it... Or you have forgotten how to. Holding this mirror to yourself can be both daunting and painful. THIS IS THE HARDEST BIT. That's ok. Don't worry about it. I'm going to say it for you. ‘I’m not okay’. ‘This is not okay’. One day soon, you'll find you're able to say it aloud To yourself...For yourself. Perhaps, you'll be in the shower... or in your bed...or having a cup of tea... or running .... or sat with a colleague...you'll be able to say them aloud. Until then, I'll say it for you ~ I'm not ok. This is not okay. Lean in because I've got a secret for you. Ready? Here goes.... You’re are not alone. I’m going to say this again because it’s important and I want you wherever you are to hear me - you're not alone. A couple of years into the madness called Covid-19.... it's fair to say there is a lot of us out here who are not well - More so for our healthcare workers. As a doctor, I can safely say it's worse in medicine because we are soooo good at FAKING IT. We’re trained to fake it. We wear a mask all the time. Sometimes the only time the mask comes off is in shower when we’re alone...or worse still at the end of a rope. Tragic. 4 doctors come to mind and 2 near misses pre-pandemic. Many many more lives have been lost since. I want you to know you're an important member of our unique tribe. There’s not a single soul that can replace you. Not one. They might be able to do the job BUT they can’t bring your unique beautiful soul, personality, heart, empathy, compassion, words, humour, smile and healing hands... because they're not you. There is only one of you in the whole universe. So, do we want to hang on to you???.... 100% YEAH! We need you to be well though. Time to start Healing This bit you’ll need support with. Speak to someone. Start with a colleague, a supervisor, a friend/family, you may well be surprised by how kind and compassionate the people around you are. That said, having lived through this myself, it's incredibly difficult to have this conversation, when you're already exhausted, low, possibly unwell, feeling desperately vulnerable, raw and numb at the same time.... It's not easy. The good news is the culture and attitudes of self care and self compassion within healthcare have started to gradually shift for the better. So, try the people closest to you. Give them a chance to anchor you. Speak to your GP. We are your colleagues and we are here for you too. I'm often saddened that I don't see enough healthcare workers especially doctors coming forward even for baseline check-ups....I can count on one hand how many doctors I've seen since the pandemic began. Please please please get in touch with your GP. To your healing journey, I'll add a box of tissues because those tears, if not already here will make an appearance at some point. Don't be scared of them. As you recover, the tone of those tears will become both cathartic and healing. Don't rush the process Time is going to be your greatest asset throughout this journey. It takes more than just a couple of weeks to even start healing. That's ok because this healing journey is more of a marathon than a sprint. It's a one day at a time, little and often approach. To be fair, somedays it'll be an hour at a time. That too is okay. Do what is needed. You're my hero You’re more courageous than you know and much stronger than you feel. When you feel fragile or the inner sceptic in your mind is casting doubtful looks or as they say giving you the side eye... remember this. You're more courageous and stronger than you know. We all are. None of us asked or are trained for this crazy that we are living in AND working within. You and I (and a few of us out here) ... could’ve bailed at any point.... and would’ve have been justified in doing so. Yet, each day we've somehow managed to put one foot in-front of the other and keep on walking. Bravo! Bravo I say! Someday we’ll look back at these chapters of lives and wonder at the audacity.... courage it took to persevere. Be Gentle With Your Soul. For now be gentle with yourself. Be kind. Grab a box of tissues. Get some help and take the time you need. There is still love and light in this world. DM if you want or need a listening ear. Big hug xoxo For those in the U.K. Well-being support services for doctors and medical students. https://www.bma.org.uk/media/6063/20220380-wellbeing-support-services-directory-update-august-2022.pdf Support for healthcare staff https://resolution.nhs.uk/services/claims-management/support-for-healthcare-staff/ Shout and PH Crisis Support Text Service A confidential 24/7 text service for PH patients. For anyone in a crisis anytime anywhere. Text shout NHSPH on 85258 https://www.practitionerhealth.nhs.uk/shout-crisis-support-text-service If you're outside the U.K. and you know of good support services for PH, feel free to share it in the comments box, including which regions the services supports. I'm certain it will help someone and may even save a life. Thank you x

Why I dislike the word Resilience and prefer Anchoring when talking about physician well-being. On resilience Let me tell you a little secret...I hate the word resilience. Actually, that's not quite right. What I mean to say is, I've come to hate the word resilience. You heard that right. Hate it. My relationship with 'that' word started about 5 years ago. It seemed to be the word of choice to describe...you know what. A bit like the word 'unprecedented' during the pandemic. Several years on, I can safely say I've developed a mild form of PTSD triggered by that word. It makes me nauseous. I know I definitely can't attend any seminars on resilience. I usually break out in a light sweat and I have to walk out. I bet you're wondering why? I recently started reading a book (now abandoned as too close to the bone) called Also Human: the inner lives of doctors. In it, I found this quote, which I'll use to explain why resilience doesn't work me. ''...The patients we work with have fallen through the ice in the middle of a frozen lake...My job - the doctor's job, should you choose it - is to go out to them, to be with on the thin ice, and to work with them to get them out of frigid water...'' Anyone capable of stepping on to that thin ice to begin with despite their personal circumstances, history, traumas, life events, grief and journeys... This person IS RESILIENT. Especially if one's life encompasses all of the above personal circumstances and more. The idea of making this person more resilient is a bit presumptuous. This is what I refer to as 'ridiculous dressed in a dollop of pseudo-compassion'. When this person is asked to become more resilient, it’s akin to saying to them that they need learn how to be better at standing and walking on thin ice. If it cracks under your feet and you go down, well you learn from that...be more resilient. It places an unhealthy proportion of responsibility, and creates a vacuum for blame and shame to thrive. In healthcare thin ice represents finite resources, poorly funded and inadequately staffed healthcare systems. These are the circumstances most healthcare professionals (not just doctors) will step into. It also does not take into account the personal and collective cumulative fatigue, emotional exhaustion, moral injury and decision fatigue. So when I'm sat in yet another seminar or conference about 'how to be more resilient' in healthcare, I find myself deeply frustrated. The conversation needs to change perhaps to a focus on 'how we keep ourselves safe 'on the thin ice'. ''...but... you should know that if you go out...on to the thin ice... there is a real danger that you'll fall in too...'' The sad truth is ... there are a number of doctors who succumb as a result of the job. I can personally think of a handful of doctors I've worked with throughout my career who've either died or nearly died as a consequence of the job through suicide. The number is not insignificant. From my perspective, every single doctor that has 'stepped out on to the ice' or chosen this profession is resilient. Many of us will step up and feel the thin ice groan beneath our feet. We take time, we check our footing and keep moving forward towards our patients (and sometimes loved ones). Many are exhausted, depressed and anxious. Naturally, most are transformed by the experience. Majority make it back to shore and bravely step out again. They do it over and over until they retire. Sadly, there are some who feel the ice groan, then crack...sometimes it's a slow process, giving people just enough time to try grab hold of them and pull them to shore. For others, it's so fast, no one sees it coming. They're gone almost in the blink of an eye. Just missing. It is not because they're 'not resilient'. If anything, maybe... just maybe...they may have been 'too resilient'. So, if resilience doesn't work for me then what does? I prefer Anchoring. It seems to me to be a more holistic and compassionate approach to physician well-being. Anchoring ''...So, if you go into this work, you've got to be anchored to the shore. You can reach out with one hand to the person in freezing water...BUT... the other hand needs to have a firm grip on the people and the things that connect you to the shore. If you don't, you'll lose both your patient and yourself...'' This quote has stayed with me. It resonates deeply with my personal journey as a doctor. Each person courageous enough to take on the practice of medicine, to witness the joys and sorrows, ill-health, death, cradle to grave, IS resilient. It is a risky business to stand on 'thin ice'. Truly worthwhile but risky because lives are involved. The more one does it, the higher the risk or some form of harm. So, how does one stay safe in this environment? One anchors oneself. 'A firm grip on the people and things that connect you to the shore'. Anchoring to the shore I prefer the word anchoring to shore. It is not easy to do this job without being anchored to something or someone that provides strength and support. The Anchor may be people, things, friends, mentors, colleagues, neighbours, hobbies, nature, pets, home, Faith, community. The list is as endless. The Anchors not only provide strength but they also help replenish and heal the mind, body, spirit and soul. This in turn enables the Anchored person, in this case the physician, to continue with their vocation of stepping on to the ice. It also helps feed the Joy, Hope, Faith, Light and dare I add, humour to those vast spaces of suffering and ill-health. (Re)Discovering the things that anchor me The conversation from resilience to anchoring for me, occurred sometime in 2020. We were in throes, of the pandemic at that stage. Then one fine day, the proverbial thin ice, gave way under my feet, while I was out doing the job. The anchors, which I had been so sure of and had neglected to check and look after...suddenly was not strong enough to hold. I had to retreat to the shore line, to find my footing, to heal and re-build. This is what I discovered about my anchor and what it consisted of. Family. It wasn't just about spending time with them, it was knowing that they were in good health. Both my parents are older and my mum is a nurse (who happily worked throughout pandemic patient-facing despite having retired in the previous year). Lockdown meant that like many people I didn't see them for over a year. Friendship. I discovered a handful of my friendships were restorative when I needed anchoring. So, I let them know and leaned on them (when they had they emotional bandwidth). *Sometimes a friend is only able to anchor for a season or maybe not all. Perhaps, they need anchoring. This IS ok. There value as friends does not diminish. I too am an anchor for others. We all form a network of anchors….anchoring each other, anchoring our neighbours, strangers as well as friends. This is life. Mentors. Well I have a handful and trying to poach one or two more. Hahaha. One of these is the epitome of the word Anchor. They are anchor I often run to when I need safe ground. Colleagues. I have a group of women who've become a sisterhood of sorts. They're on the ice with me and we look out for each other. If any of us has a wobble we all reach out to steady and strengthen. Silence. The irony of ironies. Those who know me personally, know I'm complete chatterbox, a bit opinionated in certain things and have a clever/funny retort for many things. Yet, when it comes to anchoring, resting, replenishing, it is in silence that I found this. Silence and quiet rest periods. Go figure. So.... I went on long walks in nature alone, picked up acrylic painting and crocheting. Good nutrition, hydration and sleep. I know...as old as the gospel this one. But sometimes I forget and often needed to be reminded. Well-being and health. My GP, dentist, therapist. The triad of well-being MOT. Faith. Especially in my periods silence. Actively nurtured. I needed it. Some of the things on my list are universal and others are unique to me. The trick I think, is to figure out what the unique combination is for each person. Each person needs to encouraged and supported to go on this journey. Perhaps the appraisal could include this aspect because this is a compassionate and holistic way of staying safe and healthy in healthcare. ***It is worth mentioning that not everyone will understand or agree with the concept of the Anchoring. Some people in my life really wanted to be a part of the anchor. I realised they took from me what I was incapable or unable to give because of the demands of the profession. I had to learn to be brave enough to step away from this energy with kindness and compassion. This too was okay...is okay. Lean onto the anchor frequently '...Remember walking on thin ice to rescue our patients...' Learn to lean on to the anchor regularly. Otherwise, the job can become overwhelming with sorrow, fatigue and with an increased risk to one's well being. Personally, I lean onto my anchor daily in small doses. Every 6-8 weeks, I take some time out replenish and to check that my anchor will hold. Leaning onto that anchor frequently, also means we absorb the light, hope, compassion and joy. This we then transmit to our patients and the people around us especially when they most need it. Reading. Excerpt from - Also human: the inner lives of doctors. By Carol Elton

The volume of patients wasn’t the worst that I’d experienced. Not by a long shot. But the tragedy and rollercoaster of emotions was perhaps one of the most draining and heart breaking. Some days are 'straight-forward-ish'. Then there are those 'other' days when by sheer coincidence or for me 'the guy upstairs' you get several people coming in with related pathology. And then there is the heavy stuff... 'one of those days'. So let me tell you about 'one of those days'. 'Shortly after 6.30pm, on what was an ordinary working day, I was seeing off my last patient of the day. On the way out, I caught my reflection. What struck me the most was the bloodshot eyes and puffy face. If I'm honest with myself, I looked haggard'. In one day, I’d seen one of the most severe presentations of a skin condition of a person, to hearing the distress on the voice of newlywed man who’d just lost his partner in a completely senseless way, to a mature couple who'd never wanted children seeking a termination, to a single woman who after various rounds of IVF and a successful delivery - only to be diagnosed with end-stage cancer, who wanted a safe space to cry (away from the family), to a child who’s distressed cry still keeps me awake at night. Sure there were some beautiful moments in the day. Yet as I sit here today, the thing that won’t leave me is the sadness, the grief, those dark moments in the lives of my patients. The art of dissociation In medical school, we are 'taught' the art of dissociation. We don't really talk about it. Or at least, it was not discussed when I was in medical school. Yet, I can recall almost too vividly the moment I understood dissociation was 'a thing'. It happened sometime between the 1st anatomy session in the lab and my first clinical encounter with a patient. Dissociation, is an unspoken skill that is chiselled into the fabric of doctors. To use Jada Pinkett's Smith's word on this - whatever happens don't get into an emotional or psychological 'entanglement' with the emotions in the consultation room. You HAVE to leave it behind. This time round I could not dissociate. Not even a tiny little bit. The empath and fully human part of me was present in every encounter. So each experience hit me like a wave. I found myself immersed in the lives of my patients. My heart breaking for each of them as they shared chapters of their lives. Even today, sat here scribbling away...I can picture their faces. On being a generalist (in the middle of the world) Over the span of ... well however many years I've been at this... I still stand by the following: The greatest privilege one can bestow on another human being is Trust. In particular - Trusting a person to accompany you during the dark moments we encounter as part of our lived human experience. As a doctor, when I go to see my doctor whom I've entrusted with my health (my most precious commodity), I feel vulnerable. Despite all the medical knowledge and experiences, I... feel... vulnerable. Even if I'm attending for the most benign of reasons or a follow up, I feel vulnerable. When one is on the patient's seat, one is expected to share deeply personal and sometimes embarrassing symptoms. Let's face it, not many people fancy talking about their bowel habits... or how often they pass wind... or that since they had their breast cancer removed they're terrified of intimate or sexual relations with their wives/husbands/partners. That's before getting to the examination (part of the consultation). It can feel painfully awkward. With this in mind, I can't begin to comprehend how much more vulnerable our patients feel during some of these encounters. I don't take for granted the amount of trust that is bestowed on me (us) by the patient. This is even more poignant, when I have to break some bad news...when it is my job to share a piece of news that they didn't see coming, which will completely turn their world on its head....like the C-word ... suspected dementia ... or the nth miscarriage...or that the time has come to put affairs in order (they are dying...soon). Yeah, it is hard, and on 'one fo those days' it feels like carrying the world on the shoulders. But....but....my goodness!!! what an honor to serve in this way. The Privilege of privileges When I find myself with red eyes and a puffy face, feeling drained at the end of 'one of those days'...I remind myself of the trust bestowed upon me and the privilege it confers. On a very human note, I'm absolutely exhausted. Actually, at the end of those days, I look like haggard. Yet, on a spiritual note, I am filled with gratitude. Gratitude for the privilege of being allowed to walk beside my patients from cradle to the grave. For example, when they receive the bit of good news they've been waiting for... or they're brought in by their parents with their first ever cold as newborns, ....or later in life when for one reason or another they can't advocate for themelves, ....or when they're approaching the end of their lives. It is the Privilege of privileges to be a line, in the last paragraph, of the last chapter of their lives. It’s something special no? Yeah, that’s why I have red eyes and a puffy face at the end of ‘one of those days’. At the end of the day The question I pose to myself is....did I do enough? did I show enough compassion? Did I make a difference? Did I help? Did I help not just in the way that I could but in the way they needed me to? Did I show up for my patients with both the physician and human? Does it make a difference?

Reflections on end of life and detachment Here's the thing. I thought the next or rather my first blog would be something upbeat but...I've just finished reading Tuesdays with Morrie by Mitch Albom. I can't quite shake Morrie off. Naturally, I thought I'd write about it. That and I made a vow to myself to be authentic, honest and faithful. This for me means, the first audience has to be me. Otherwise, this whole space feels inauthentic...written in a 'voice' that is not mine and with words that don't reflect who I am. So here goes....Let's Medi(c/t)ate with Morrie. An extract from Tuesdays with Morrie “And this is where detachment comes in. If I die in the middle of a coughing spell like I just had, I need to be able to detach from the horror, I need to say, ‘This is my moment.’ “I don’t want to leave the world in a state of fright. I want to know what’s happening, accept it, get to a peaceful place, and let go. Do you understand?” Mortality. We all have to face it at some point. Now that I‘m young, I'd like to think (...or rather NOT think at all) ... about what the end may look like for me. When (not if) the time comes, I hope it shall we quick, painless, peaceful, surrounded by family and of course as a Catholic, I'll have had the Sacraments of Confession and the Last Rights. Yet… like most people, I know not the time, place, mode or mechanism. Assuming for a second the worst… I prefer Morrie’s approach, which is to try and detach from the moment. Let's establish that as far as I'm aware, I'm not dying. I'm not ready...not that being ready has anything to do with it. Life happens. Life happens to all of us. Like Morrie, I don't want to leave this world in a state of fright. I want to walk out of my life with dignity... full of Joy, Love and perhaps even a small dose of humour. Thus, it is not surprising that Morrie's way appeals to me. Recognise, accept, DETACH and step into Joy. 'Recognise, Accept, Detach, Step into Joy'. This brings me to my next question. Is it possible??? Is it possible to find Joy... in those last days, hours, minutes or moments despite the unique circumstances for each soul. Is it possible for each (or any) soul to detach from the circumstances and look beyond the moment? My personal experience of looking after patients (and their loved ones) approaching the end of life suggests that it is not impossible. Lessons from a patient approaching the end of life Morrie brings to mind a patient of mine who was dying. The last chapters of their life were dragged out and filled with more complications one body should have to handle. During one of their last admissions into hospital, I had the task of informing this particular patient's family that their loved had deteriorated. Things were not good and they needed to come in. They made their way to hospital, as had become the norm after such phone conversations. When the family arrived, they were ushered into the bed space. There lie the patient with every bit of medical equipment attached to their body…. heaving away, which was no mean feat given the critical illness. Me...silent in room, trying to straddle that fine balance between being ‘visible’ as a source of support for the patient AND their family while being ‘invisible’ because this Sacred space and moment belongs exclusively to the family. The partner turned to me and said one the most profound things I’ve ever heard ~ Death is not a crisis ~. A minutes later the patient opened their eyes and with a serene smile added '...No it’s not. Death is not a crisis. But I wanted to see your beautiful faces', drawing an uncomfortable chuckle from everyone in room. This moment changed the tone of the room and of those last days. Having calmly taken in the unusually serene room (all the more remarkable due to the constant whirring and beeping of various medical equipment), the patient slipped into yet another series of complications. This turned out to be the last admission. They succumbed several weeks later. ....death is not a crisis... Death is not a crisis (contextual of course). This phrase has stayed with me since then. Experiencing Morrie as he approached his end of life, brings all my patients and their families (and my own) to mind. As a HCP, a doctor, I have enough insight and unfortunate experience to know that sometimes life happens. Even with the very best medical, nursing care, all the resources available and the best will in world, people die. Sometimes we have little or no control of the unique circumstances. In those moments, I believe... I have to believe that it is possible to step into Joy on the way out. After all, I have the example of some of my patients. It is possible to die with dignity and Joy. To do that, we must Recognise, Accept, Detach and then Step into Joy. On a more personal note, if by chance there's family, the Sacraments (the Catholic thing again for me), humour and perhaps a bit of sunshine, then I shall be even more Joyful. I'll leave this here for now. We need to talk about How to Practice the Subtle Art of Detachment in day to day life and it's benefits (not just at the end of life).

Medi(c/t)ation is derived from the words #medicine #medic #medication #meditation #medical life and medicine ..... and everything in between Dear reader, thank you for joining me on this little venture. The Medi(c/t)ation blog is for me a space to reflect, explore, learn, heal and grow. Reflection or rather reflective practice has its place at the core of medicine. This is reflected in the mandatory component of our medical career journey, starting during medical school to retirement and beyond. It is a life-long habit. Yet due to the volume of work, training pathways, psycho-social strain, exams, life ... the process runs the risk of being reductive. It is compounded by other parties who act as 'monitors' to ensure that the process is a) taking place b) relevant to the specialty and clinical pathways c) a form of governance structure to evidence competency. These are all good objectives in themselves. During my 10+ years in healthcare service, I've learnt that there are some lessons and observations that cannot fit into this model of reflection. The Medi(c/t)ation blog is for that other learning that occurs in the space 'where life and medicine meet'. That space where life and medicine meet ... that's where the greatest growth occurs for me. It is the soil, which nurtures my practice of medicine. It has shaped me into a 'wholesome' human and more compassionate doctor.